Persistent metabolic acidosis and frailty trajectories after kidney transplantation: a prospective cohort…

Cohort studyClinical and experimental nephrology· Jul 2026

Persistent metabolic acidosis and frailty trajectories after kidney transplantation: a prospective cohort study.

Lucian Siriteanu, Andreea Covic, Călin Namolovan … Adrian Covic

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GeriatricsCohort studyPrognosisQ2IF 2.3

Persistent metabolic acidosis after kidney transplantation was associated with worsening frailty over 24 months

Persistent metabolic acidosis and frailty trajectories after kidney transplantation: a prospective cohort study.

Lucian Siriteanu … Adrian Covic

Clinical and experimental nephrology · Jul 2026

Background

Metabolic acidosis is common after kidney transplantation and has been linked to adverse graft outcomes, but its potential contribution to functional decline has not been prospectively evaluated.

Purpose

We investigated whether persistent metabolic acidosis is associated with longitudinal frailty trajectories in kidney transplant recipients.

Methods

In this prospective single-center cohort study, 239 adult kidney transplant recipients were followed for 24 months.

n = 239 adult

Results

worse frailty over 2 years with longer-lasting low blood bicarbonate

pOR 1.52 (95% CI 1.12 to 2.06)

null 0

1.12

2.06

CI excludes the null - significant

More results

Frailty prevalence at 24 months increased progressively with greater acidosis persistence, from 7.4% in patients without acidosis to 27.4% among those with persistent acidosis (p for trend = 0.004).

Persistent acidosis was also associated with higher frailty scores in linear mixed models (β 0.31 per category increase, p < 0.001).

“

Conclusion

Persistent metabolic acidosis was associated with worsening frailty trajectories after kidney transplantation, suggesting that persistent low bicarbonate may represent a clinically relevant marker of functional decline, although causality cannot be established.

Persistent metabolic acidosis and frailty trajectories after kidney transplantation: a prospective cohort study.

Persistent metabolic acidosis and frailty trajectories after kidney transplantation: a prospective cohort study.

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